MEDICARE: PROF. SHELLEY ELIZABETH MULLIGAN PHD., OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	1068	NH

General Provider Information

NPI Number	:	1346445723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. SHELLEY ELIZABETH MULLIGAN PHD., OTR

Provider Business Mailing Address
First Line	:	4 ROCKY LN
Second Line	:
City	:	DURHAM
State	:	NH
Zip	:	03824-1947
Country	:	US
Telephone Number	:	603-862-3528
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 LIBRARY WAY
Second Line	:
City	:	DURHAM
State	:	NH
Zip	:	03824-3520
Country	:	US
Telephone Number	:	603-862-3528
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/08/2007

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